Subjective assessment of mastication as parameter for successful prosthetic therapy

Introduction. Success in functional rehabilitation of the craniomandibular system in patients without teeth, which have total prosthesis, can be assessed using different clinical and functional methods. Subjective assessment, motivation, comfort level and functional efficacy are important elements for adaptation to dental prosthesis as well as base for success in prosthetic therapy. The aim of this study was to evaluate the importance of subjective assessment of the mastication in people with new dental prosthesis as well as to assess the value of that parameter in determining the successful prosthetic therapy. Material and Methods. Study was conducted at the Dental Clinic in Novi Sad. Thirty patients (16 males and 14 females) with average age of 62.5 years who received total prosthesis were included. Analysis was done according to the data from the medical records and conducted survey in the form of questionnaire which was adjusted to our clinical examinations. Results. Results showed that 96.6% of the patients were satisfied with new prosthesis. Subjective assessment of the quality of their mastication before therapy showed that 63.4% consider their mastication as unsatisfied, 26.6% satisfied while 10% of toothless patients thought their mastication was good. Statistic analysis showed there was significant difference in subjective assessment before and after the therapy (p<0.01). In fact, there was significant connection between subjective assessment of the mastication and satisfaction with new prosthesis and therapy at all (p<0.01). Conclusion. Patients satisfaction with total prosthesis and subjective assessment of mastication are in direct correlation with successful prosthetic treatment. Results of subjective assessment of the mastication are important and can be used as a parameter for success along with precise survey

Okluzalni splint - alternativa u terapiji bolesnika sa temporomandibularnim disfunkcijama

Introduction/Objective The pain that originates from musculoskeletal structures of the mastication system is one of the symptoms belonging to the category of temporomandibular disorders or temporomandibular dysfunction (TMD). The objective of the research was to evaluate the effect of therapy with stabilizing occlusal splint in the control of painful symptoms of TMD in comparison with the effect of drug therapy. Methods Using standard Research Diagnostic Criteria for Temporomandibular Disorders diagnostic protocol proposed by Dworkin and LeResche, a group of 44 patients with painful TMD was included. The patients were divided into three treatment groups by random selection. The first group was treated with stabilization occlusal splint for a period of one month. In the two control groups, therapy with non-steroidal anti-inflammatory drug ibuprofen (Brufen, Mylan, Canonsburg, PA, USA) or a combination therapy of ibuprofen and diazepam, a medication from the benzodiazepine family (Diazepam, Hemofarm, Vršac, Serbia) was carried out over a period of three weeks. In order to assess the effects of the therapy with stabilizing occlusal splint and the drug therapy, before and after the therapy, pain intensity measurements were performed with visual analogue scale and digital pressure algometer. Results A significant reduction in the intensity of painful symptoms was achieved in all three therapeutic groups. No significant differences in the effectiveness of pain reduction between the proposed therapeutic modalities were noted. Conclusion The obtained results confirm that the therapy with stabilization occlusal splint is a valid procedure in the reduction of pain in patients with TMD.Uvod/Cilj Bol porekla mišićno-skeletnih struktura mastikatornog sistema predstavlja jedan od simptoma koji pripadaju kategoriji temporomandibularnih poremećaja ili temporomandibularnih disfunkcija (TMD). Cilj istraživanja je bio da se proceni efekat terapije stabilizacionim okluzalnim splintom u kontroli bolnih simptoma TMD u poređenju sa efektom terapije lekovima. Metode Korišćenjem standardnog dijagnostičkog protokola (RDC/TMD) predloženog od strane Dvorkina i Lerešea, izdvojena je grupa od 44 bolesnika sa bolnim temporomandibularnim disfunkcijama. Bolesnici su podeljeni u tri terapijske grupe slučajnim izborom. Prva grupa je podvrgnuta terapiji stabilizacionim okluzalnim splintom u periodu od mesec dana. U dve kontrolne grupe je sprovedena terapija nesteroidnim antiinflamatornim lekom ibuprofenom (brufen, Mylan) ili kombinacijom ibuprofena i leka iz grupe benzodiazepina - diazepama (diazepam, Hemofarm) u periodu od tri nedelje. U cilju procene efekata terapije stabilizacionim okluzalnim splintom i terapije lekovima, pre i posle sprovedene terapije izvedena su merenja intenziteta bola vizuelnom analognom skalom i digitalnim pritisnim algometrom. Rezultati U sve tri terapijske grupe postignuto je značajno smanjenje intenziteta bolnih simptoma. Nisu zabeležene značajne razlike u uspešnosti smanjenja bola između predloženih terapijskih modaliteta. Zaključak Dobijeni rezultati potvrđuju da je terapija stabilizacionim okluzalnim splintom validna procedura u smanjenju bola kod bolesnika sa TMD

HOW MEDICAL STUDENTS IN THEIR PRE-CLINICAL YEAR PERCEIVE PSYCHIATRY AS A CAREER: THE STUDY FROM BELGRADE

Background: Taking the Initiative to evaluate students’ affinity toward psychiatry seems to be a global issue and is an essential part of programs to improve the status of the profession. The aim of this study is to explore medical students’ attitudes toward psychiatry in comparison to other residencies (internal medicine, surgery, pediatrics, gynecology and general medicine) in the pre-clinical year and to observe which factors influence the creation of these attitudes. Subjects and methods: The survey included 114 students of the second year, School of Medicine in Belgrade (academic year 2007/08). The data was collected trough a 23-item questionnaire. Results: Fifteen percent of students stated that psychiatry was their career of choice, while 25% expressed a strong aversion. Psychiatry was ranked less attractive than internal medicine, surgery and pediatrics, but more attractive than general medicine or gynecology. Those who like psychiatry attributed more importance to an interesting and challenging job than to prestige and financial reward. Also, they found this field to be intellectually challenging and to rapidly expand the frontier of medicine. Students with negative attitude were convinced that psychiatry was lacking in scientific foundation and was clinically inefficient, they disliked intensive emotional involvement, exposure to stress and frequent unpleasant situations and had prejudices toward the patients or simply a lack of the interest. Conclusion: The present study is the first of its kind in Serbia which used a precise and internationally comparable methodological instrument and It shows that pre-clinical medical students at the University of Belgrade, have a stronger affinity towards psychiatry when compared to their peers from most countries worldwide. Also, the study points out the fact that prejudices toward patients with mental dysfunctions and lack of confidence in the efficacy of psychiatric treatment should be specially targeted by the curriculum in the later part of undergraduate education. How this will affect the attitude of clinical students and graduates is to be examined

Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions

Background/Aim. Patients receiving long-term oral anticoagulant therapy pose a clinical challenge during invasive dental procedures. The goal of this study was to compare different local hemostatic modalities after tooth extraction in patients receiving chronic Vitamin-K antagonist therapy. Methods. Totally 90 patients with International Normalized Ratio (INR) ≤ 3.0 requiring simple extraction of one or two teeth were randomized into three groups, 30 patients in each group. The patients with the mean INR value of 2.35 ± 0.37, in whom extraction wound was sutured comprised the group A. In the group B with the mean INR of 2.43 ± 0.4, local hemostasis was achieved by placing absorbable gelatin sponges into the wound without suturing. The group C consisted of the patients with the mean INR of 2.36 ± 0.34 in whom neither gelatin sponge nor suturing were used for providing local hemostasis. Bleeding was registered as an event if other than initial hemostatic measure was needed or additional oral surgeon intervention required. Results. The obtainded results show that 1 (3.3%) patient in the group A, 2 (6.7%) patients in the groups B and C manifested post-extraction bleeding. All cases of hemorrhage were easily solved with local hemostatic measures and all, except one case, were registered in the first two hours after the procedure until the dismissal. A difference between the groups was not statistically significant (χ2 = .42, p > 0.05). Conclusion. In therapeutically anticoagulated patients tooth extractions can be safely performed without altering the dose of anticoagulant medication if efficient local hemostasis is provided. In most cases, in patients with INR ≤ 3.0 after extraction of one or two teeth postoperative bleeding can be controlled with local pressure, without any additional local hemostatic measures

Development of Light-Polymerized Dental Composite Resin Reinforced with Electrospun Polyamide Layers

As the mechanical properties of resin-based dental composite materials are highly relevant in clinical practice, diverse strategies for their potential enhancement have been proposed in the extant literature, aiming to facilitate their reliable use in dental medicine. In this context, the focus is primarily given to the mechanical properties with the greatest influence on clinical success, i.e., the longevity of the filling in the patient’s mouth and its ability to withstand very strong masticatory forces. Guided by these objectives, the goal of the present study was to ascertain whether the reinforcement of dental composite resins with electrospun polyamide (PA) nanofibers would improve the mechanical strength of dental restoration materials. For this purpose, light-cure dental composite resins were interspersed with one and two layers comprising PA nanofibers in order to investigate the influence of such reinforcement on the mechanical properties of the resulting hybrid resins. One set of the obtained samples was investigated as prepared, while another set was immersed in artificial saliva for 14 days and was subsequently subjected to the same set of analyses, namely Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and differential scanning calorimetry (DSC). Findings yielded by the FTIR analysis confirmed the structure of the produced dental composite resin material. They also provided evidence that, while the presence of PA nanofibers did not influence the curing process, it strengthened the dental composite resin. Moreover, flexural strength measurements revealed that the inclusion of a 16 μm-thick PA nanolayer enabled the dental composite resin to withstand a load of 3.2 MPa. These findings were supported by the SEM results, which further indicated that immersing the resin in saline solution resulted in a more compact composite material structure. Finally, DSC results indicated that as-prepared as well as saline-treated reinforced samples had a lower glass transition temperature (Tg) compared to pure resin. Specifically, while pure resin had a Tg of 61.6 °C, each additional PA nanolayer decreased the Tg by about 2 °C, while the further reduction was obtained when samples were immersed in saline for 14 days. These results show that electrospinning is a facile method for producing different nanofibers that can be incorporated into resin-based dental composite materials to modify their mechanical properties. Moreover, while their inclusion strengthens the resin-based dental composite materials, it does not affect the course and outcome of the polymerization reaction, which is an important factor for their use in clinical practice